体外循环心脏手术后胃肠道并发症的综合治疗探究

COMPREHENSIVE TREATMENT OF GASTROINTESTINAL COMPLICATIONS AFTER CARDIOPULMONARY BYPASS SURGERY

目的通过观察体外循环心脏手术后胃肠道并发症的临床特征、危险因素、早期诊断、综合治疗以及预后干预措施,探讨体外循环心脏手术后胃肠道并发症的综合治疗措施。方法回顾我院2002年2月-2013年10月收治的56例体外循环心脏手术（心脏瓣膜置换术32例,冠状动脉搭桥14例,心脏瓣膜置换术＋冠状动脉搭桥术5例,大血管手术3例,先心病矫治术2例）术后发生胃肠道并发症的患者临床资料,分析胃粘膜保护机制削弱、损伤因素作用增强及机体的神经内分泌功能失调三方面在体外循环心脏术后胃肠道并发症的发生、发展、转归中的作用,总结体外循环心脏手术后胃肠道并发症的综合干预措施。结果 1例原有消化溃疡病史,因大量出血,死于休克;其余55例患者均痊愈出院。对55例患者进行为期1-5年的随访,均无复发和死亡情况。结论体外循环心脏手术后胃肠道并发症病死率高,对术前有胃肠道病史、术前心功能差等高危患者术前可采取必要的预防措施,术后对并发症早期诊断、早期采取综合干预措施,可以提高生率,达到很好的治疗效果。

Objective To study the comprehensive treatment of gastrointestinal complications after cardiopulmonary bypass surgery by observing clinical features,risk factors,early diagnosis,comprehensive treatment and prognosis of gastrointestinal complications observed after cardiopulmonary bypass surgery. Methods The clinical data of56 patients admitted from February 2002 to October 2013 and developing gastrointestinal complications after undergoing cardiopulmonary bypass surgery,including 32 cases of heart valves replacement,14 cases of coronary artery bypass surgery,5 cases of heart valves replacement combined with heart valves replacement,3 cases of large vessel surgery,and 2 cases of congenital heart disease surgery,were retrospectively reviewed and analyzed for investigating the influence of weaken protective mechanism of gastric mucosa,enhanced damage factors,and neuroendocrine function disorders on the appearance,development and prognoses of the gastrointestinal complications after cardiopulmonary bypass surgery,and summarizing the comprehensive intervention measures of the gastrointestinal complications after cardiopulmonary bypass surgery. Results 1 patient with the original history of peptic ulcer died of shock form severe bleeding,while the other 55 patients were cured,without recurrence and death during the follow- up for 1 to 5 years.Conclusion Gastrointestinal complications after cardiopulmonary bypass surgery has a high mortality. We can improve the survival rate and reach a good therapeutic effect by taking some necessary precautions for high- risk patients with the history of gastrointestinal diseases and poor cardiac function before cardiopulmonary bypass surgery and some comprehensive intervention measures in the early diagnosis of complications after the surgery.